To survive, focus on coding, efficiency
Now that President Clinton and Congress have asked the Health Care Financing Admini-stration (HCFA) to implement a prospective payment system (PPS) for hospitals by calendar year 1999, and surgery centers are expected to have a PPS in 1998, what can you do to prepare? Here’s advice from same-day surgery experts:
• Study the accuracy of your coding. "Make sure for certain that your CPT coding is absolutely accurate," says Deborah Williams, senior associate director for policy development at the American Hospital Association in Washington, DC. Ensure your coder has proper training, she advises.
A HCFA official, who under agency policy spoke on condition of anonymity, says HCFA will ask hospitals to be more accurate in reporting. "We will be coming out with some more billing instructions in the next six months or so to have hospitals more accurately reports their units of service," also known as frequency of service, she says. HCFA will determine whether the number of procedures performed on a patient in a short time seems unreasonable. If so, providers will be asked for supporting information. "The units of service how many times something is done is very important, particularly under PPS, because you’re paid on the basis of how many times something is done rather than billed charges," the official says.
• Efficiency will take on a new meaning. The balanced budget bill, which dictated the PPS, removed a lot of money from Medicare, Williams warns. "When [hospitals and surgery centers] see the rates, they’re going to be surprised. You’ll have to become much more efficient, unfortunately."
Joel Perlman, CPA, senior vice president of finance at Montefiore Medical Center in the Bronx, NY, agrees. "It’s all about knowing your costs, managed care resource utilization, effectively monitoring the use of those resources, and establishing appropriate care guidelines and case management approaches to delivering care," he says.
Education and information technology will be critical, he says. "Certainly, an educational process needs to be undertaken to orient all the caregiving teams: doctors and all support personnel," Perlman says. "Investments in information system, so critical to understanding our business, are already under way everywhere but will be accentuated by programs such as this."
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